9. peter hill


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9. peter hill

  1. 1. Aligning research with policy: the Evidence for Health Policy in Viet Nam (VINE) project <ul><li>Ass Prof Peter S Hill </li></ul><ul><li>School of Population Health </li></ul><ul><li>The 2 nd International Conference on Public Health </li></ul><ul><li>among Countries in the Greater Mekong Sub-Region: 30 August 2010 </li></ul>
  2. 2. Evidence-based policy: the global call <ul><li>Limited resources, escalating costs, increasing demand, epidemiological shifts </li></ul><ul><ul><li>Particular issues for Viet Nam as a MIC </li></ul></ul><ul><ul><li>Need for equitable resource allocation, effective and efficient interventions </li></ul></ul><ul><li>Global demand for evidence to guide policy, to link research, policy, outcomes </li></ul><ul><li>Confidence that evidence can drive change </li></ul>
  3. 3. Evidence for Health Policy In Viet Nam (VINE) Project <ul><li>The VINE project: UQ and MOH collaboration </li></ul><ul><ul><li>Funded through the Atlantic Philanthropies </li></ul></ul><ul><ul><ul><li>Health Strategy and Policy Institute </li></ul></ul></ul><ul><ul><ul><li>Can Tho Medical University </li></ul></ul></ul><ul><ul><ul><li>Hanoi Medical University </li></ul></ul></ul><ul><ul><ul><li>Hanoi School of Public Health </li></ul></ul></ul><ul><ul><ul><li>HCMC University of Medicine and Pharmacy </li></ul></ul></ul><ul><ul><ul><li>Hue University of Medicine and Pharmacy </li></ul></ul></ul><ul><ul><ul><li>Thai Nguyen Medical University </li></ul></ul></ul>
  4. 4. Four ‘branches’ of VINE <ul><ul><li>Reliable mortality and cause of death data </li></ul></ul><ul><ul><ul><li>By age, gender, cause, using Verbal Autopsy </li></ul></ul></ul><ul><ul><li>Burden of Disease analysis </li></ul></ul><ul><ul><ul><li>Combine mortality with morbidity to calculate combined health burden and to compare </li></ul></ul></ul><ul><ul><li>Cost-effective Analyses </li></ul></ul><ul><ul><ul><li>Select key BOD issues and examine most cost effective policy interventions </li></ul></ul></ul><ul><ul><li>Policy analysis </li></ul></ul>
  5. 5. Building the Evidence <ul><li>The evidence is increasingly clear: </li></ul><ul><ul><li>Validated data on mortality and causes </li></ul></ul><ul><ul><li>Initial BOD completed </li></ul></ul><ul><ul><ul><li>Injury, stroke, mental health, cancer, NCDs </li></ul></ul></ul><ul><ul><li>CEA on Tobacco control completed </li></ul></ul><ul><ul><li>CEA on Alcohol, Hypertension, Diabetes, HIV, Mental health soon available </li></ul></ul><ul><li>But translation into policy faces challenges </li></ul>
  6. 6. Policy analysis: the challenges <ul><li>But the policy process is not rational: it is complex and depends on multiple factors </li></ul><ul><li>VINE policy process faces 5 challenges: </li></ul><ul><ul><li>The challenge of chronology </li></ul></ul><ul><ul><li>The challenge of priority </li></ul></ul><ul><ul><li>The challenge of persuasion </li></ul></ul><ul><ul><li>The challenge of adequacy </li></ul></ul><ul><ul><li>The challenge of sustainability </li></ul></ul>
  7. 7. The policy process: a theoretic framework <ul><li>Kingdon (1994) suggests policy action happens when 3 streams converge: </li></ul><ul><ul><li>The ‘problem’ stream: the issue is on the agenda </li></ul></ul><ul><ul><li>The ‘policy’ stream: there are solutions available </li></ul></ul><ul><ul><li>The ‘politics’ stream: there is a will for change </li></ul></ul><ul><li>The evidence cycle needs to coincide with the policy cycle to influence change </li></ul><ul><li>VINE project is now entering ‘policy’ stream </li></ul>
  8. 8. The challenge of chronology: getting our timing right <ul><li>Media analysis on helmet legislation </li></ul><ul><ul><li>Using media to understand the policy process </li></ul></ul><ul><li>Tobacco CEA available for proposed legislation </li></ul><ul><ul><li>Costings based on pre-determined interventions </li></ul></ul><ul><ul><ul><li>Able to demonstrate cumulative effects </li></ul></ul></ul><ul><ul><ul><li>But can also demonstrate potential for choices not made </li></ul></ul></ul><ul><li>Alcohol CEA currently examined by Hue Uni </li></ul><ul><ul><li>‘ Problem’ stream: scale of issues not yet recognized </li></ul></ul>
  9. 9. The challenge of priority: getting new issues on the agenda <ul><li>Burden of Disease analysis directly compares combined mortality/morbidity </li></ul><ul><li>Calculates priority listings for policy, but: </li></ul><ul><ul><li>Mental health – high on BOD, but not on agenda </li></ul></ul><ul><ul><li>Tobacco – recognized risk factor, complex politics </li></ul></ul><ul><ul><ul><li>State-owned industry – short term economic perspective </li></ul></ul></ul><ul><ul><ul><li>Projected impact: exposure, gender, aging population </li></ul></ul></ul><ul><ul><li>Alcohol – dynamic social, economic context </li></ul></ul>
  10. 10. The challenge of persuasion: right arguments for right audiences <ul><li>Some interventions directed at individual at risk: </li></ul><ul><ul><li>‘ Quit’ campaigns for smokers </li></ul></ul><ul><ul><li>Brief interventions for ‘hazardous’ drinkers </li></ul></ul><ul><li>Some need population shift for individual action: </li></ul><ul><ul><li>Mandatory helmet legislation </li></ul></ul><ul><li>Some need whole population strategies for effect: </li></ul><ul><ul><li>Legislation to decrease salt content of foods </li></ul></ul><ul><ul><li>Smoke-free public areas to reduce passive exposure </li></ul></ul>
  11. 11. The challenge of adequacy: getting ‘enough’ evidence for action <ul><li>There are crucial time-frames for policy action </li></ul><ul><ul><li>Definitive evidence takes time to provide </li></ul></ul><ul><ul><li>‘ Good-enough’ evidence is sometimes enough </li></ul></ul><ul><ul><li>May need to construct from international experience </li></ul></ul><ul><ul><li>Enough evidence may never be ‘enough’ </li></ul></ul><ul><li>Tobacco: current smoking impact in 30 years </li></ul><ul><li>Sex ratio at birth: once confirmed, too late to act </li></ul><ul><li>Mental health: interaction with aging population </li></ul>
  12. 12. The challenge of sustainability: translating the evidence into action <ul><li>Initiate identified interventions and measure change </li></ul><ul><ul><li>Standardize medical certification in hospitals against VA </li></ul></ul><ul><li>Evaluate current interventions, measure effectiveness </li></ul><ul><ul><li>Savings from decreased TBI from helmet legislation </li></ul></ul><ul><li>Identify synergies from potential interventions </li></ul><ul><ul><li>Breath alcohol enforcement and alternative transportation </li></ul></ul><ul><li>Advocate new policy alternatives and project CEA </li></ul><ul><ul><li>Plain packaging for cigarettes </li></ul></ul><ul><ul><li>Salt reduction legislation </li></ul></ul>
  13. 13. <ul><li>Thank you and our partners: </li></ul><ul><ul><li>Health Strategy and Policy Institute </li></ul></ul><ul><ul><li>Government Statistics Office </li></ul></ul><ul><ul><ul><li>Can Tho Medical University </li></ul></ul></ul><ul><ul><ul><li>Hanoi Medical University </li></ul></ul></ul><ul><ul><ul><li>Hanoi School of Public Health </li></ul></ul></ul><ul><ul><ul><li>HCMC University of Medicine and Pharmacy </li></ul></ul></ul><ul><ul><ul><li>Hue University of Medicine and Pharmacy </li></ul></ul></ul><ul><ul><ul><li>Thai Nguyen Medical University </li></ul></ul></ul>
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